Education and Postgraduate Education of Psychiatrists in the Soviet Union and Their Integration into a New Milieu. A View from the Present to the Past of Former Soviet Psychiatrists
Lerner, Vladimir, Frolova, Katherine, Witztum, Eliezer, The Israel Journal of Psychiatry and Related Sciences
Abstract: The article presents the problems and difficulties that psychiatrists from the former Soviet Union (FSU) have to cope with in Israel. Immigration and acculturation in a new milieu is a complex process and even more complicated for those whose specialty is medicine and particularly psychiatry. There is a wide gap between the skills and knowledge that new immigrants brought with them from the FSU and the professional demands in the new country. Psychiatry and psychiatric education in the FSU were determined by the cultural practices and traditions of the region and the organizational principles of the USSR which were very different than those of western society and the State of Israel. In comparison to the West, postgraduate psychiatric training in the USSR was shorter and less rigorous with an emphasis on biological therapy. Soviet "psychotherapy" was more reality oriented and more authoritarian than in the West, stressing "collective" group therapy. We describe the basic principles of Soviet medical education and the radically different social, intellectual and political history of the former Soviet Union. We relate the experiences of psychiatrists in the FSU in learning dynamic psychotherapy and the difficulties connected with this education. Moreover, the process of educating psychiatric residents is described from a supervisor's point of view. This complex process led to some major difficulties. In order to cope with the difficulties the supervisor employed a broad variety of means and techniques: an introductory course and a basic seminar about fundamental cornerstones of psychotherapy were offered.
Immigration is a process involving significant cultural and psychological changes and, in some cases, may even lead to psychopathological reactions (1). Several waves of immigration from the countries of the former Soviet Union brought to Israel more than 1,000,000 people. Though the immigrants came from different ethnic communities, the difficulties they face are the same. The problems are substantial and largely interrelated; they pertain to the integration into a new, unfamiliar culture, the acquisition of a new language, the creation of new relationships in new surroundings, the reorganization of relationships within the family structure, the struggle for social and professional recognition, the search for suitable employment and housing, and the attainment of an appropriate lifestyle, to name just a few (2-4).
Medicine was a preferred career choice among Soviet Jews. Since the last wave of immigration over 10,000 physicians immigrated to Israel from the FSU. The transition from the FSU to Israel was a highly stressful and complicated process (5,6). During their absorption the physicians underwent the painful process of professional adjustment that was connected with differences in specific medical professions, and psychiatry was one of them. Soviet psychiatrists were educated differently, e.g., they were not trained in the psychodynamic approach to psychotherapy.
In order to better understand Soviet psychiatry and psychology we will describe and compare it with other traditions in Western Europe, Britain and North America. The essential nature of Soviet psychiatry and psychology cannot be understood without some basic knowledge of the Soviet system of medical education.
Medical Education: How it Was
The medical education system was built on the organizational principles of the USSR. Medical schools (medical institutes) were under the jurisdiction of the Ministry of Health and were separated from the universities (that were under the jurisdiction of the Ministry of Education). Soviet medical education could be divided into two stages: the first is general medical education, in medical institutes (six years + a year of a clinical specialization), and the second is postgraduate medical education (7).
In medical institutes there was a unique feature of Soviet medical education: student scientific societies under the tutorship of a professor in the form of a professional seminar. …